Hepatitis C Direct-Acting Antivirals (Sofosbuvir-velpatasvir, Glecaprevir-pibrentasvir)

Direct-acting antivirals (DAAs) for hepatitis C

Sofosbuvir-velpatasvir (Epclusa) — pangenotypic, 12 weeks. Glecaprevir-pibrentasvir (Maviret) — pangenotypic, 8 weeks for most. Sofosbuvir-velpatasvir-voxilaprevir (Vosevi) — for prior treatment failures. Older: sofosbuvir-ledipasvir (Harvoni) — genotype 1 only.

DAAs target specific hepatitis C virus enzymes essential for viral replication. They directly stop the virus from making copies of itself. Modern combinations have 2-3 drugs targeting different parts of the virus, achieving cure rates of 95-99%. The era of interferon injections is over.

**Sofosbuvir-velpatasvir (Epclusa)**: 1 tablet daily for 12 weeks.

**Glecaprevir-pibrentasvir (Maviret)**: 3 tablets together, once daily, with food, for 8 weeks (most patients) or 12-16 weeks in cirrhosis.

Very important: take EVERY dose without missing. Skipping doses can cause resistance.

• New jaundice or worsening of cirrhosis symptoms — Rare hepatic decompensation — stop and contact your doctor.

• Severe rash, mouth ulcers, fever — Possible serious allergic reaction.

IMPORTANT — many drug interactions. Common problematic combinations: amiodarone (cardiac arrest with sofosbuvir), strong CYP3A4 inducers (rifampin, carbamazepine, phenytoin, St. John's Wort), some statins, some antiretrovirals. ALWAYS review your full medication list with your doctor before starting.

Before starting: HCV RNA, genotype (newer drugs are pangenotypic), liver function, hepatitis B (must screen for occult HBV — risk of HBV reactivation), kidney function, drug interactions.

During treatment: typically no monitoring beyond clinical check-in.

After: HCV RNA at 12 weeks post-treatment to confirm cure (sustained virologic response = SVR).

Don't stop early — even if feeling well or no detectable virus. Complete the full course. Stopping early causes treatment failure and resistance.

NOT recommended in pregnancy — limited safety data. Effective contraception during treatment and for some time after (varies by drug). If you become pregnant on treatment, contact your doctor.

Saudi MOH provides free DAA treatment for diagnosed hepatitis C patients through specialized clinics. Many private centers also treat. Saudi Arabia is on track for WHO global hepatitis C elimination by 2030.

• How long will my treatment be?

• What's my chance of cure?

• Will my insurance cover this?

• Can I get reinfected after cure?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the SGA Patient Education Panel. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.